Erhardt Preitauer

New for 2025, CMS is rolling out a geographically based targeting option for Medicare Advantage organizations based on an Area Deprivation Index. If these orgs get things right, this could mean opportunities with new enrollees (especially in Midwest and Southern states) with potential rewards, incentives, and reduced cost sharing. This is in addition to CMS’ 2025 proposal to draw from ACO REACH and its geographic adjustments (which saw some big winners). If finalized, savvy ACOs would have additional capabilities through prepaid shared savings. tl;dr, CMS continues to push geographic considerations for beneficiaries. #sdoh #healthequity #medicare #medicaid .Variate Health

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Next year, payers will need to increase member communication on supplemental benefits, per new rules from Centers for Medicare & Medicaid Services. Find our summary of the changes and ways to reduce related operational challenges: https://lnkd.in/gz6PN7g2

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The growth of the health insurance marketplace is picking up steam, fuelled by Medicaid disenrollment. https://ow.ly/N1vW50Tafsq MMIT’s Erin Trompeter explains what these large-scale changes mean for providers, manufacturers, payers and health IT vendors. Get the insights by clicking the link in this post. #HealthInsuranceMarketplace #HealthInsurance #Medicaid

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Strong Coordination of Benefits (COB) programs help state Medicaid agencies run at peak efficiency with minimal waste. By helping states either recover or avoid improper payments, COB programs allow healthcare funds to be better allocated for member care. #Medicaid #HealthcareEfficiency #CostSavings

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#MedicareAdvantage keeps getting more popular among seniors: #MA plans typically offer a range of supplemental benefits (like transportation/#NEMT) that can improve quality of life and health outcomes. But they are facing challenges headed into 2025, including lower star ratings, resistance from some health networks, rising healthcare costs, and a revised CMS payment model. Read our latest blog for a summary of MA changes that will impact health plans, providers, and members in the year ahead. https://hubs.li/Q02XP0700

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We’re proud to announce our strategic partnership with Holzer Health System to help primary care providers in Ohio and West Virginia deliver more proactive, patient-centered care for Medicare beneficiaries. Through this partnership, Holzer providers will gain access to data insights, financial tools, provider enablement technology, and a broad range of services designed to improve patient care and drive success in value-based Medicare programs. With more than 160 providers across multiple outpatient clinics, hospitals, and post-acute services, Holzer has expanded the boundaries of care delivery in rural communities, offering unparalleled access to primary care physicians, specialists, skilled care teams, leading technology, and advanced healthcare services. We’re excited to work alongside the Holzer team to help primary care providers enhance the quality of care for their Medicare patients. Read the press release to learn more. https://lnkd.in/gjfbJEfi #valuebasedcare #medicare #healthcareinnovation #primarycare 

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Nearly all Medicaid health plans participate in #ValueBasedCare initiatives, but just over half of those plans cite there are still barriers to adopting the model according to the Institute for Medicaid Innovation’s annual managed care survey. Survey findings noted the following challenges in implementing value-based care models: ✅ Provider readiness or willingness 🧑‍⚕️ Staff capacity 📊 Lack of sufficient/complete data 💻 Information technology system preparedness With the right resources and education, value-based care can have a positive impact on quality of care and patient outcomes. However, we must equip providers with the #data, infrastructure and talent to support value-based models. I’m encouraged by the opportunity these findings present to continue building awareness, and I’m hopeful we can continue to find ways to ease the transition from the fee-for-service model.

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New CMS report: The Medicare Shared Savings Program (MSSP) continues to demonstrate its effectiveness in delivering high-quality care while generating significant cost savings. Key highlights from the report: - MSSP generated $1.8B in savings for Medicare in 2022 - 483 ACOs participated, serving 11 million Medicare beneficiaries - 99% of ACOs successfully reported quality measures - 54% of ACOs earned shared savings payments These outcomes reinforce that VBC can drive care quality while improving financial outcomes for the ACOs who participate. Check it out here: https://lnkd.in/dJDNU6-c #Valuebasedcare #healthcareinnovation #ACOs #Medicare

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Big Changes to Star Ratings Proposed! Are You Ready? (Effective MY2024/MY2025)  https://lnkd.in/gViJDedt The Centers for Medicare & Medicaid Services (CMS) recently proposed significant changes to the Medicare Advantage Star Ratings program, effective for Measure Years (MY) 2024 and 2025. These changes, driven by a focus on health equity and improving overall quality of care, present both challenges and opportunities for health plans. Our blog dives into the key details of these proposed changes and explores how Health Chain's Centaur Data Platform can help you navigate the new landscape and achieve higher Star Ratings. Don't wait! Get a head start on understanding the implications for your organization.  #Medicare #Healthplans #healthcare #MAStarRatings #HealthChain #HCInsights 

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The era of splashing the market with flashy supplemental benefits is in the rearview as CMS, MA plans, and downstream risk-bearing providers are collectively challenged to "do more with less."   CMS' heightened data collection requirements will slowly but surely drive an emphasis on cost-saving, impact-driving supplemental benefits rather than those that simply attract members.   This shift could serve risk-bearing providers well, as overly generous and unmanageable supplemental benefit allowances have often driven MLR headwinds in recent years.

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Listen Here: https://lnkd.in/gMEkNNTS This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Krischa Winright, President of Medicare Advantage at Blue Cross Blue Shield of Michigan. Here, she discusses sustainable solutions for seniors on Medicare, focusing on providing seamless access to healthcare. Winright also examines market shifts in the post-COVID era and highlights the importance of strengthening partnerships with providers to enhance care delivery and outcomes. For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #healthcare #leadership

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The new #CMS requirement for a bibliography containing 10+ years of evidence for #SSBCI in bids to show that benefits have a reasonable expectation of improving or maintaining health and function felt like a tall task when codified earlier this year. But thanks to Better Medicare Alliance and ATI Advisory, this utterly stellar #MedicareAdvantage #supplementalbenefits literature database will make the effort easy, efficient and reliable. A sincere thanks to John Gorman for sharing this truly fantastic tool! Hoping my #MA #StarRatings friends will take the time to examine this carefully as you sit at the 2026 bid prep table - when your actuaries ask you which benefits you need for MY2026 #Stars success, we encourage you to use this to show the ROI of investing in product/benefits to drive your now-3x-weighted #HOS measures. This should help you end the lunacy of trying to tackle HOS (and #CAHPS) as an afterthought through postcards, mailers and texts. This is the path to #HealthEquity to tactically tackle #SDOH.

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As a health system, should you expand geographically or focus on service line specialities? Or both? These are the types of questions we help hospitals and health systems answer. HSG Advisors partners with healthcare leaders to identify opportunities for profitable top line growth through data- and experienced-informed strategies. #healthcareconsulting #HSGStrategy #hospital #healthsystem #healthcareleader #revenue

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"Rarely have the pathologies of the Medicare Physician Fee Schedule portended such poor outcomes for the future of U.S. healthcare as they do now." In a new Healthcare Financial Management Association (HFMA) blog, APG President and CEO Susan Dentzer describes the four main flaws in the Medicare Physician Fee Schedule. "Those of us hoping for a better system for paying physicians should keep pushing for alternative payment models." #valuebasedcare #Medicare #healthcarecosts Read the blog: https://lnkd.in/dGVE8dfM

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A Don’t Miss Reveleer Webinar: Patient-centered Prospective Risk Adjustment Join CareOne Consulting's Donna Page and Reveleer's Roxanna Cross & Anthony Polizzi as they share their unique perspectives on the benefits – and challenges – of implementing a more holistic, patient-centric view to risk adjustment. Gain valuable insights into: • How a more holistic approach can improve care delivery and outcomes • Importance of clinical documentation • Value of securing data outside a patient's EMR • The role of HIEs • Challenges that will need to be overcome • Best practices to integrate holistic patient data into risk adjustment models When Date: August 21, 2024 Time: 10:30 a.m. PST / 1:30 p.m. EST Learn more and register here: https://bit.ly/3WQv5d4 #RiskManagement #QualityImprovement #ValueBasedCare #Integration #RISEwebinars #Reveleer

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Medicare Advantage unrest, Change Healthcare fallout and more big takeaways from insurers’ Q1 https://lnkd.in/eyg48k7e via Healthcare Dive #MedicareAdvantage #ChangeHealthcare #Cybersecurity #CMS #Medicaid

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This Thursday the Energy and Commerce Committee will hold a hearing on the Centers of Medicare and Medicaid Improvement (CMMI). Members of the Committee are expected to raise concerns and praise for the agencies' efforts to test and achieve savings in value-based payment models over the years. Since its inception in 2010, CMMI has tested many new payment models including bundled payments, multiple accountable care organization offerings, and the making care primary model. The agency continues to face challenges, such as finding ways to engage rural providers and solo or small physician specialty practices. Reps. Michelle Steel and Susie Lee and Sens. Markwayne Mullin, Kyrsten Sinema and Thom Tillis introduced the EASE Act (HR 7149 / S.4078) to encourage CMMI to create a new payment model for rural and underserved communities to reduce long wait times that many seniors and residents face in these communities when seeking care from a specialist. The bill was developed based on years of data collected and reviewed by OCHIN to help community health centers and rural hospitals improve care integration and create a new value-based payment model. While Congress looks for ways to improve outcomes and reduce costs; and medical schools continue to look for ways to grow the physician workforce, one pathway that would fill the needs of communities (especially rural areas) and prevent avoidable hospital admissions is the EASE Act which looks to utilize telehealth or e-consults to help our most vulnerable populations receive timely care

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